Fighting malnutrition

Adoum's story

Adoum is a little girl, eight months old. She wears dangling earrings that reach her chin and has a big brother at home that she likes to play with. Adoum is one of more than 350,000 children in Chad who are malnourished.

Leaving home in the early morning hours on her donkey, her mother Achta has brought Adoum to the health centre in the nearby village of Bogole.

The health centre in Bogole covers the needs of dozens of villages in a huge area. Mothers spend hours walking or riding their donkeys to bring their kids to the feeding station. Credit: OCHA/Philippe Kropf

Mothers gather in the shadow waiting for their children's turn. Many will spend the entire day at the health centre. Credit: OCHA/Philippe Kropf

Every child who arrives at the centre is weighed and measured. The circumference of the upper arm is taken as an indicator for malnutrition - less than 115 millimeters indicates severe acute malnutrition. Credit: OCHA/Philippe Kropf

A young patient gets a check-up from a nurse. Often, infections like Tuberculosis or HIV can accompany malnutrition, so medical staff are always on the look out even when their patients seem to be recovering. Credit: OCHA/Philippe Kropf

Bogole is situated in the Kanem region, in Chad’s arid Sahel belt, where malnutrition rates persist well over the emergency threshold of 15 per cent. Families here have an average of six children, which means that almost every household is touched by malnutrition.

So, every Thursday, the small health centre becomes a feeding centre. "On some days we have up to 200 women coming in with their kids," says Guy-Salomon Djeugueme, the nurse in charge.

Adoum fidgets nervously as medical staff weigh and measure her and test her for diseases. An appetite test establishes that she has the energy and will to eat. Her mom is given 11 sachets of Plumpynut, a peanut paste containing sugar, oil, milk powder and enriched with vitamins and minerals. The ration is enough to feed Adoum for seven days. Then she will return to the health centre for a follow-up.

Plumpynut comes in sachets and can easily be administered outside of clinical settings. Credit: OCHA/Philippe Kropf

Insufficient harvests

“If the mothers don’t share the rations with other children, the kids are getting better quite fast,” says Djeugueme. That’s a big ‘if.’ Because food is so scarce, Djeugueme knows that the rations will likely be shared among siblings. “Right now, we may have something small for breakfast and for dinner,” says Achta. “But there is not enough for a third meal.”

In the Sahel, the lean season runs from October until June. This year is especially bad.

“The rains stopped too early,” says Jean-Jacques Niyonkuru field coordinator for the international NGO Action Against Hunger (ACF). “If households do not have enough to eat, there is a direct impact on the nutritional status of their children.”

Mothers detect malnutrition

ACF has been working in the Kanem since 2008 when the entire Sahel suffered through a major food crisis. “Despite the humanitarian response and all our activities, the needs are still extremely high,” says Niyonkuru. “If malnutrition is not taken care of, children die.”

ACF has adopted a community-based approach to tackling malnutrition. Mothers are taught how to detect the early signs of malnutrition, for example by measuring the width of their children’s arms. “Since ACF changed its strategy, women don’t have to come here unless it is necessary,” says Djeugueme.

Complications with malnutrition, however, require additional interventions beyond what can be provided in Bogole. For such cases, referrals are made to a hospital in the provincial capital of Mao, about 40 km away.

"When they come, they are already very weak."

In the hospital in Mao, Dr. Boubacar and his team take care of malnourished children with medical complications, such as Mariam's baby son.

Losing precious time

The children who are sent to Mao need intensive medical support. Some arrive too late.

“Almost all children admitted here, have first seen traditional healers”,” says Dr. Amadou Boubacar, ACF’s doctor at the hospital. This practice robs children of precious time and can also leave physical scars as some traditional healers practice scarification or extract teeth in a misguided effort to treat the symptoms of malnutrition.

"The children are already extremely weakened by the malnutrition,” says Dr. Boubacar. “Their immune system has no strength left."

On the afternoon that we visited Mao, a young child around Adoum’s age, named Mohamed, arrived at the centre already in critical condition. “We directly put him under oxygen, started the antibiotics treatment,” says Dr Boubacar. “But he went into respiratory arrest. We lost him.”

Saving Adoum

Children referred from the ambulatory feeding centres, mostly arrive in time. There are vehicles available to transfer them as soon as necessary, and bring them back.

Achta herself has already lost one child to malnutrition.

“There was no other disease. It was just malnutrition,” she says. “We simply had waited too long before we went to the feeding centre.”

She is determined to save Adoum from a similar fate.

"Now we know better"

Achta hopes that now that the mothers in her village can better recognise the early signs of malnutrition, their children will get the help they need in time.